We read with interest the report by Bais et al. describing two familial cases combining features of ADPKD and genetically confirmed Alport syndrome (AS) 1. While the clinical narrative is compelling, their discussion omits our recent cohort study 2, the largest to date (n=257 with 990 exome-negative controls), which found no significant association between AS and multiple kidney cysts (MKC). Our findings argue against integrating MKC within the AS spectrum. Cysts may occur in AS, especially with aging or vascular comorbidities, but they lack specificity and should not guide diagnosis.